title: The suborbicularis oculi fat (SOOF) and the fascial planes: has everything already been explained?
abstract: OBJECTIVE
  During anatomic and surgical dissections, a connection was seen between the superficial layer of the deep temporal fascia and the prezygomatic area. These findings were in contrast to previous evaluations. This study defines this connection, which is important to understand from both surgical and anatomic standpoints.
  
  
  OBJECTIVE
  To define the connection between the superficial layer of the deep temporal fascia and the prezygomatic area and demonstrate the presence of a deep fascial layer in the midface.
  
  
  METHODS
  Anatomical study performed at the Laboratoire d'Anatomie de la Faculté de Médecine de Nice, Sophia Antipolis, France; at the Centre du Don des Corps de l'Université Paris Descartes, Paris, France; and at the Department of Experimental Medicine, Histology, and Embryology Unit of the University of Pavia, Pavia, Italy. Twenty-four hemifaces of 14 white cadavers were dissected to define the relationship between deep temporal fascia and the midface. Four biopsy samples were harvested for histologic analysis.
  
  
  METHODS
  Dissection of 24 hemifaces from the fresh cadavers revealed the following findings. There is a connection of the deep fascia of the temple (superficial layer of deep temporal fascia) to the midface that divides the fat deep to the orbicularis muscle into 2 layers. One layer of fat is the so-called suborbicularis oculi fat (SOOF), which is superficial to the deep fascia, and the other layer of fat (preperiosteal) is deep to the deep fascia and adherent to malar bone. These findings are in contrast to previous anatomical findings. RESULTS In 12 hemifaces, the superficial layer of the deep temporal fascia directly reached the prezygomatic area as a continuous fascial layer. In 16 hemifaces, the superficial sheet of the deep temporal fascia inserted at the level of the zygomatic and lateral orbital rim and continued as a deep fascial layer over the prezygomatic area. In all specimens, a deep fascial layer was present in the prezygomatic-infraorbital area. This deep fascial layer is adherent to the muscles of the infraorbital area, and it divided the fat located deep to the orbicularis oculi muscle into 2 layers: the SOOF and a deeper layer. Histologic examination of the biopsy samples confirmed these findings.
  
  
  CONCLUSIONS
  This study demonstrates the existence of a deep fascial layer in the midface. This fascia is connected to the superficial layer of the deep temporal fascia, and it divides the fat deep to the orbicularis oculi muscle into 2 layers. This new finding carries interesting implications related to the classic concept of the superficial musculoaponeurotic system.
  
  
  METHODS
  NA.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Pavia, Pavia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Andretto Amodeo
authors.affiliation: Histology and Embryology Unit, Department of Experimental Medicine, University of Pavia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Casasco
authors.affiliation: Histology and Embryology Unit, Department of Experimental Medicine, University of Pavia, Pavia, Italy.
authors.forename: Antonia
authors.initials: A
authors.lastname: Icaro Cornaglia
authors.affiliation: Department Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles4now with the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Kang
authors.affiliation: Department Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Keller
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology; D002102:Cadaver; D002610:Cheek / Q000033:anatomy & histology*; D004210:Dissection; D005205:Fascia / Q000033:anatomy & histology*; D006801:Humans; D013703:Temporal Muscle / Q000033:anatomy & histology*; D015050:Zygoma / Q000033:anatomy & histology*